Starvation is a severe deficiency in caloric energy intake. It is the most extreme form of malnutrition. In humans, prolonged starvation can cause permanent organ damage[1] and eventually, death. The term inanition refers to the symptoms and effects of starvation.

According to the World Health Organization, hunger is the single gravest threat to the world's public health.[2] The WHO also states that malnutrition is by far the biggest contributor to child mortality, present in half of all cases.[2] Undernutrition is a contributory factor in the death of 3.1 million children under five every year.[3] Figures on actual starvation are difficult to come by, but according to the Food and Agriculture Organization, the less severe condition of undernourishment currently affects about 842 million people, or about one in eight (12.5%) people in the world population.[4]

The bloated stomach, as seen in the picture to the right, represents a form of malnutrition called kwashiorkor which is caused by insufficient protein despite a sufficient caloric intake.[5] Children are more vulnerable to kwashiorkor whose advanced symptoms include weight loss and muscle wasting.[5]

The basic cause of starvation is an imbalance between energy intake and energy expenditure. In other words, the body expends more energy than it takes in. This imbalance can arise from one or more medical conditions and/or circumstantial situations, which can include:

The most common cause of starvation is the economy; poor people sometimes cannot buy enough foodstuffs and thereby fail to fulfill the caloric demands of the body.

Starvation may be due to food scarcity in the society. This causes decreased supply of food to the whole of the population, and thus mass starvation may occur.

Starvation may be due to diseases that can cause rapid weight loss either due to the nature of the disease or the inability of the person to either eat or eat enough due to symptoms including, but not limited to: fatigue, nausea, or vomiting. The person may also be the host to a parasite such as an intestinal worm which may take a significant amount of the calories ingested by its host. This effect is exacerbated if the human host is already ingesting far less food than is required to meet their daily caloric intake needs.

There are some clinical conditions such as recovering from surgery or burns etc., in which the person may be too fatigued or incapacitated to eat enough during their period of convalescence.

There is insufficient scientific data on exactly how long people can live without food.[6] Although the length of time obviously varies with an individual's percentage of body fat and general health, one medical study estimates that in adults complete starvation leads to death within 8 to 12 weeks.[7] There are isolated cases of individuals living up to 25 weeks without food.[8] Starvation begins when an individual has lost about 30% of his normal body weight.[9] Once the loss reaches 40% death is almost inevitable.[9]

Early symptoms include impulsivity, irritability, hyperactivity, and other symptoms. Atrophy (wasting away) of the stomach weakens the perception of hunger, since the perception is controlled by the percentage of the stomach that is empty. Victims of starvation are often too weak to sense thirst, and therefore become dehydrated.

All movements become painful due to muscle atrophy and dry, cracked skin that is caused by severe dehydration. With a weakened body, diseases are commonplace. Fungi, for example, often grow under the esophagus, making swallowing painful.

The energy deficiency inherent in starvation causes fatigue and renders the victim more apathetic over time. As the starving person becomes too weak to move or even eat, their interaction with the surrounding world diminishes.

There is also an inability to fight diseases, and in females, irregular menstruation can occur.

Starving patients can be treated, but this must be done cautiously to avoid refeeding syndrome.[11] Rest and warmth must be provided and maintained. Small sips of water mixed with glucose should be given in regular intervals. Fruit juices can also be given. Later, food can be given gradually in small quantities. The quantity of food can be increased over time. Proteins may be administered intravenously to raise the level of serum proteins.[12]

For the individual, prevention consists of ensuring they eat plenty of food, varied enough to provide a nutritionally complete diet. Short of sitting in front of a potentially starving person and offering him or her food, addressing societal mechanisms by which people are denied access to food is a more complicated matter.

Supporting farmers in areas of food insecurity through such measures as free or subsidized fertilizers and seeds increases food harvest and reduces food prices.[13]

Many organizations have been highly effective at reducing starvation in different regions. Aid agencies give direct assistance to individuals, while political organizations pressure political leaders to enact more macro-scale policies that will reduce famine and provide aid.

According to estimates by the Food and Agriculture Organization there were 925 million under- or malnourished people in the world in 2010.[14] This was a decrease from an estimate of 1023 million malnourished people in 2009.[15] In 2007, 923 million people were reported as being undernourished, an increase of 80 million since 1990-92.[16] It has also been recorded that the world already produces enough food to support the world's population.

As the definitions of starving and malnourished people are different, the number of starving people is different from that of malnourished. Generally, far fewer people are starving, than are malnourished. The numbers here may provide some indication, but should not be quoted as a number of starving people.

The proportion of malnourished and of starving people in the world has been more or less continually decreasing for at least several centuries.[17] This is due to an increasing supply of food and to overall gains in economic efficiency. In 40 years, the proportion of malnourished people in the developing world has been more than halved. The proportion of starving people has decreased even faster.

Year

1970

1980

1990

2004

2007

2009

Proportion of undernourished people in the developing world[15][18][19]

Historically, starvation has been used as a death sentence. From the beginning of civilization to the Middle Ages, people were immured, or walled in, and would die for want of food.

In ancient Greco-Roman societies, starvation was sometimes used to dispose of guilty upper class citizens, especially erring female members of patrician families. For instance, in the year 31, Livilla, the niece and daughter-in-law of Tiberius, was discreetly starved to death by her mother for her adulterous relationship with Sejanus and for her complicity in the murder of her own husband, Drusus the Younger.

Another daughter-in-law of Tiberius, named Agrippina the Elder (a granddaughter of Augustus and the mother of Caligula), also died of starvation, in 33 AD. (However, it is not clear whether or not her starvation was self-inflicted.)

A son and daughter of Agrippina were also executed by starvation for political reasons; Drusus Caesar, her second son, was put in prison in 33 AD, and starved to death by orders of Tiberius (he managed to stay alive for nine days by chewing the stuffing of his bed); Agrippina's youngest daughter, Julia Livilla, was exiled on an island in 41 by her uncle, Emperor Claudius, and not much later, her death by starvation was arranged by the empress Messalina.

In Sweden in 1317, King Birger of Sweden imprisoned his two brothers for a coup they had staged several years earlier (Nyköping Banquet). According to legend they died of starvation a few weeks later, since their brother had thrown the prison key in the castle moat.

Saint Maximilian Kolbe, a martyred Polish friar, underwent a sentence of starvation in Auschwitz concentration camp in 1941. Ten prisoners had been condemned to death by starvation in the wake of a successful escape from the camp. Kolbe volunteered to take the place of a man with a wife and children. After two weeks of starvation, Kolbe and three other inmates remained alive; these were then executed with injections of phenol.

The Makah, a Native American tribe inhabiting the Pacific Northwest near the modern border of Canada and the United States, practiced death by starvation as a punishment for slaves.[20]